Provider Demographics
NPI:1316526148
Name:BERG, ERICH J (DO)
Entity type:Individual
Prefix:DR
First Name:ERICH
Middle Name:J
Last Name:BERG
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SOUTH JACKSON STREET
Mailing Address - Street 2:ACB, 3RD FLOOR
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-852-5666
Mailing Address - Fax:502-852-8980
Practice Address - Street 1:302 W 14TH ST STE 100A
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3751
Practice Address - Country:US
Practice Address - Phone:812-284-0660
Practice Address - Fax:812-284-3822
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN02008197A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program